Introduction

In 2010, the European Respiratory Society (ERS) celebrates its 20th anniversary, as reported in the editorial published on page 14 of this issue, which is an elaborated Italian version of Nikos Siafakas' editorial. "The European Respiratory Society, 1990-2010: a story of success", published in first issue 2010 of the European Respiratory Journal (ERJ) [1].

In writing his editorial, Siafakas invited each of the former presidents of the Society (Table 1) to comment on what for them were the highlights of their term in office. Not all were able to respond to the invitation, unfortunately. In particular, the president for 1991-1992, Jean-Claude Yernault is no longer with us; Yernault, who was one of the outstanding figures in the history of the ERS, passed away in 2004. The report which follows is a synthesis of the reflections that were received from those former presidents who did respond and, despite some gaps here and there, it offers an interesting insight into the course of events that have shaped the remarkable history of the ERS in its first twenty years of life.

1992-1993 - Roberto Rodriguez-Roisin described his ERS presidential term as marked by few achievements. They were very modest times in which the most important goal was to consolidate the recent, basic roots of the ERS organization and its simple logistics in order to avoid any attempt of secessions, quite common during the previous decade of the 80 s. He recalls however four highlights:

the move, at the end of 1992, to the first official ERS premises (a modest apartment very close to Parc de Luxembourg, Paris) before the definitive move to Lausanne. In the two years prior, the ERS had been allocated in the offices of the UICT at Blvd St Michel (in Paris also);

setting up of the first Nomination Committee to select candidates for the presidency (composed of the three former Past Presidents - there were no more - and chaired by the most recent Past President), which was launched in 1993 after the Florence Congress to propose the first three names to be submitted for final decision/election by the Executive Committee;

creation of the first database of members (and its roster), a task fraught with great difficulties due to the lack of consensus among officers within the EC concerning the best computer option. Its operational infrastructure and set-up were fragile and modest;

in 1993 the groundwork was laid by Jean-Claude Yernault, Past president, for the Postgraduate School, with a series of meetings to define the structural format of such a successful operation (a year later, when it was launched, Yernault became the first chair of the School).

1994-1995 - Max Zach looks back on his presidency as a highly turbulent and stressful year. The society was growing rapidly (with growing pains accompanying these developments) and many of its present features were initiated then. Zach was the first Paediatrician to become president of the ERS and this nicely illustrates the integration of Paediatric Respiratory Medicine into the entity of the ERS. Yves Sybille was Secretary General at the time, and gave outstanding assistance. The mile-stones were as follows:

the move of headquarters from Paris to Lausanne. This happened under the pressure of the French tax authorities which had started to heavily tax ERS income. Nevertheless, it was done in a planned and well-designed way and with the advice of professional consultants;

the foundations were laid for setting up Assembly 9 for allied health care professionals. This was done in spite of some resistance from parts of the society which considered the ERS more or less as an instrument for doctoral formation. It was motivated by the intention to collect everybody interested in pneumology and caring for patients with respiratory disease under one roof;

problems developed in the course of the year with the Sheffield office, and changes were initiated there that ultimately led to the present situation;

the Postgraduate School was launched, with Jean-Claude Yernault as the first Chair.

1998-1999 - Robert Loddenkemper sees the keypoints of his term as follows:

the difficult situation in the Lausanne office, which was stabilized by hiring new officers (Nikolaus Lorenz, Jean-Luc Eiselé, and Eric Fassbind), although Nikolaus Lorenz was subsequently replaced by Archie Turnbull as Executive Manager;

in 1999, the European Lung Foundation was founded;

the ERS organized the World Asthma Meeting in Barcelona (December 10-13,1998) together with the American Thoracic Society (ATS), European Academy of Allergy and Clinical Immunology (EAACI), American Academy of Allergy Asthma & Immunology (AAAI), International Union Against Tuberculosis and Lung Diseases (IUATLD) and Global Initiative for Asthma (GINA), which certainly stimulated the cooperation of international respiratory societies;

the idea of a European Lung White Book was conceived (which became a reality in 2003);

more strength was given to the Eastern and Central European countries.

1999-2000 - Jacob Boe, looking back on his term as president, sees the ERS as an almost unbelievable success story. One of the milestones of the history of the ERS, moving from a small European society to a worldwide organization, occurred during his term of presidency: what was probably the first, and so far only, World Congress on Lung Health was hosted by the ERS during their 10th Annual Congress in Florence August 30 - September 3, 2000. This Congress was number one priority, and the time spent on the organizing of this event was considerable. The World Congress in Florence was a collaborative effort of the world's four major respiratory societies: ATS, Asian Pacific Society of Respirology (APSR), IUATLD and ERS, but Boe comments that the main bulk of work was undertaken by the officers of the ERS, the society that in reality hosted the event, and acknowledges in particular the great work of the two chairmen, Dario Olivieri and Andrea Rossi, of the Programme Committee chairmen, John Gibson and Marc Decramer, as well as of the ERS General Secretary Claudio F. Donner. Nevertheless, Boe also gives credit to the other collaborative Societies and their presidents: William B. Martin for the ATS, the late Ann J. Woolcock of the APSR and Kjell Bjartveit of the IUATLD.

Another point that Boe emphasizes in the ERS 20 year history is the fruitful development of the role of national delegates, as demonstrated by the great increase in the number of delegates, and the construction of the National Society Village exhibition during the congress; events that have continued to develop and expand during more or less all the ERS presidency periods.

2000-2001 - Josep Roca saw his term as reaping the benefits of the excellent task done by his two immediate predecessors: Loddenkemper had been the successful driver of a difficult transition between Paris and Lausanne, and one of his main achievements was to hire Archie Turnbull as ERS Executive Manager immediately after the opening ceremony at the Madrid congress (1999). During the year 2000, Boe and Turnbull did well devoting all the available energies to the Florence meeting with out-standing results. That was a real job for three reasons: a) the challenges of Florence in terms of logistics, b) it was a world meeting, and, c) the "weakness" of the Lausanne office at that time. During the Florence meeting, the ERS emerged with a really strong image and the society generated great expectations. Without doubt, the challenge after Florence was to build up a robust basis to successfully support the ambition of the ERS project, not defined at that time yet.

The program during Roca's period was established during an informal meeting held in Barcelona in October 2000 with the Steering Committee, other active leaders and Archie Turnbull. It was a sort of enlarged steering committee that accomplished two main objectives: a) to generate consensus; and b) facilitate a team approach. Roca admits that the relatively high speed of the changes proposed during the period and the important role of the Steering committee was not always well understood (at first sight) by some heads of assembly. But, overall, the organization followed well the whole process and the balance was generally positive.

Specific internal achievements were as follows:

Re-design of the Lausanne office with complete re-organization based on defined areas headed by qualified (and well paid) managers. The main aims were twofold: a) reinforce the main office (Lausanne) to support an ambitious international role for the ERS, and b) generate a system allowing a proper balance between the professional initiative of the managers and their accountability to the elected officers. Jean-Luc Eiselé was the only manager from the previous team who was incorporated into the new project. That has proven a good move.

Re-design of the Sheffield office. At that time, the cost of the services (mainly publications) was approximately 140% of the amount of the membership fee, which precluded any policy to expand the membership. The goals were to maintain the services to the members without increasing the membership fee while decreasing the cost of those services to less than 80% of the membership fee. The key action was to make a complete change in the Sheffield office and link it to Lausanne. The fact that the Society had bought the copyright of the ERJ during 1999 facilitated the whole operation. Everything was properly achieved during 2001.

Identification of the ERS core services to be kept within the society (i.e. science, education, key aspects of organization of the meetings, copyright of scientific/educational material, web policy, etc...). As a result, several contracts that externalized some of these services were cancelled. A very representative example was the web policy (ICT activities) that was established as a key area for the society.

Changes in other organs of the society. The main actions taken concerned the ERS School that was undergoing a major crisis at the time, but also the recently approved European Lung Foundation (ELF) (1999) was reformulated making the general public its main focus of action.

Brussels office. Advocacy in Brussels was identified as a key area and a small office was opened at the end of the period.

The external achievements were:

The idea of the Federation of International Respiratory Societies (FIRS) emerged during the first ERS-ATS retreat in Florence as an ERS response to the proposal of a World Respiratory Society made by the ATS. During 2001, the FIRS got full consolidation. Events like September 11 (New York) showed the importance of the networking at international level. It had a very positive impact on the 2001 Berlin meeting.

Inclusion of Respiratory Diseases as a priority in the World Health Organization (WHO) Program for Chronic Diseases in February 2001. The initiative markedly strengthened the collaboration between ERS and WHO. The meeting also facilitated a proper frame to articulate initiatives like Global Initiative on Obstructive Lung Diseases (GOLD) and GINA with the main International Respiratory Societies (ERS and ATS).

The European Board of Accreditation in Pneumology (EBAP) initiative was presented in Berlin 2001.

Also, the European national societies were invited to be present at the ERS annual meeting for the first time in Berlin.

2002-2003 - John Gibson recalls the completion of the White Book (large and small versions) as the main achievement during his term of presidency; it had been initiated earlier by Robert Loddenkemper, and was then launched in the EU parliament building in Brussels with support and attendance by the Health Commissioner and some MEPs.

Other highlights were the discussions held at the WHO about areas for potential cooperation, and the publication of ERJ and other ERS journals evaluated by the new Publications Committee, with the decision to continue in-house publication on the grounds of quality and value for money. The idea of an ERS educational journal was conceived (Breathe would be launched in September 2004).

2003-2004 - Walter McNicholas recalls two key developments during his term of office:

Focus on advocacy as a strategic priority for ERS, which took tangible form in: i) the establishment of an Advocacy Committee as a standing ERS committee; ii) the expansion of the Brussels office (increased staffing levels, move to larger offices).

Establishment of a Forum of European Respiratory Societies (FERS) - the objective being to increase interactions between ERS and National Societies particularly in the areas of education and advocacy.

2004-2005 - Ronald Dahl recalls a very fortunate collaboration in the Steering Committee during his term of office, and a number of structural changes that were made as part of a strategy to diversify income and give greater precision through the by-laws to job descriptions and responsibilities of the ERS officers. Income was on the rise as more participants attended the ERS congress and meetings, the membership numbers rose and the sponsors came to exhibitions, courses etc.

Efforts went towards WHO and there was an improved collaboration through ERS support to the publication of books: 'Preparing a health care work-force for the 21st century. The Challenge of Chronic Conditions' and 'Preventing Chronic Diseases. A Vital Investment'. ERS had an annual January meeting with WHO in Geneva and started to have frequent meetings in relation to the establishment of the Global Alliance against Respiratory Diseases (GARD) which today is an integrated part of WHO's non-communicable diseases department.

Relations with the EU were also stepped up: the Brussels office was reinforced and several meetings took place with the director of medical research and the commissionaire for research. ERS succeeded in getting the word 'respiratory' specifically mentioned in the 7th Framework Program, which was a major achievement at that time. For advocacy purposes ERS established an ERS officer position as 'EU Secretary' and set up the committees for 'tobacco control' and 'environmental control' to work in the EU sphere. ERS published with the European Commission the book 'Smoking or Health in the European Union' and held in Luxembourg the conference 'SmokeFree Europe 2005'.

ERS became involved in the 'GRACE' program and took on the role of organiser of courses in connection with the centres involved.

The journal Breathe was launched in September 2004. ERS changed to "Highwire" as a new hosting platform for the ERJ which resulted in a hit rates increase from 5,000 per month to over 100,000 per week. The ERJ was voted as the "best scientific journal of the year 2005" by the Association of Learned Professional Society Publishers, and Breathe had a favourable mention as a refreshing innovation.

ERS established a section to accommodate the interests in cancer, which has now become the 11th ERS assembly 'Thoracic Oncology'.

ERS established a Jean-Claude Yernault lecture on 'Education in Respiratory Medicine' to be given every third year at the annual congress in conjunction with an award based upon Education in Respiratory Medicine.

The 'Romain Pauwels Award Fund' was established through a grant from GlaxoSmithKline.

The E-Learning Resource Centre got a new web platform and established interactive case studies, a slide bank and development of interactive live presentations and web-based courses on specific topics.

To diversify income and improve ERS services, a focal point was educational activities, which went hand in hand with the need for ERS to be the natural generator of international guidelines and other educational material, often in collaboration with ATS. This was the reason behind the establishment of the 'European Training Program in Respiratory Medicine'.

HERMES (Harmonised Education in Respiratory Medicine for European Specialists): this was the practical part and basis for the education of a 'European Respiratory Physician' with the development of a consensus-based European core syllabus, development of a consensus-based European core curriculum, and the European Examination for the European Diploma in Adult Respiratory Medicine (the first examination would be held during the annual congress in Berlin 2008). The HERMES task force began work in 2005, and has now successfully completed the above three phases, all published in the HERMES booklet [2] (ndr: an Italian translation of the HERMES booklet appears in this issue of MRM, pp. 50). The whole project is a joint venture of ERS, ELF, EBAP, FERS, and the European Union for Medical Specialists (UEMS). At present, the fourth step is in progress: the "Accreditation of European Training Centres in Adult Respiratory Medicine".

For this educational purpose a standard high quality content of guidelines and procedures is necessary and this is still in development. The program has now expanded with a specific paediatric module. In relation to the educational and guideline work a position as ERS guidelines director was established. An Ethical Committee was established to be activated when necessary on specific issues to ensure an independent and unbiased view.

2005-2006 - Giovanni Viegi recalls of his Presidency:

the concept and the practice of being part of a team, not just "one man in command": when Viegi entered the Steering Committee in September 2004 after election as President-Elect in Glasgow by the ERS Council (it was the first time that a President was elected by a larger body than the Executive Committee), he immediately learnt from Walter and Ronald the spirit of the presidential cycle which lasts three years (for example, one month later, on October 2004 he was sent to represent ERS in the ALAT Congress);

the inclusion in the ERS Constitution of his proposed definition of Europe based on the structure of the European Region of the WHO: it helped greatly to expand the participation of national societies in the FERS;

the inititation, through a questionnaire that was distributed to all current and previous ERS officers, of the process of revising the ERS Strategy;

the leadership of the FIRS which helped strength-en the links among the "sister" international respiratory societies and support the work of the task forces on biomass exposure health effects (terminated with a document published on Proc Am Thor Soc (PATS) and on simple spirometry (led by Marc Zelter, soon to be published);

the launch in Beijing in March 2006 of GARD, a partnership among WHO, respiratory and allergological societies, patients associations, general practitioners, and governmental organizations;

the successful lobby campaign towards the European Parliament and the European Commission for the inclusion of respiratory and allergic diseases in the EU 7th Framework Programme for Research and Development;

the discussion with the "Marie Curie" officers and the participation in the European Conference of "Marie Curie" fellows, which prepared the basis for the new ERS-Marie Curie fellowships;

the publication in the ERJ of a series of documents of the ATS-ERS Task Force on Standardization of Lung Function Tests, which, clearly indicating the conceptual error of the GOLD guidelines in defining airflow obstruction, laid the basis for the start of a discussion on the merit of having a new international correct COPD guideline which might be endorsed by FIRS following a new methodology (GRADE) (still to be brought to realization);

the decision, after the experimental period, to make Breathe a permanent ERS publication, very much widely appreciated;

the convinced support to the various initiatives organized by ERS members, with the support of the three ERS offices: the Brussels office dedicated to the EU lobby campaign, the Lausanne headquarters and the Sheffield Publications office;

the creation of the "Environment and Health Committee" officialized in February 2006, which later on, under the excellent leadership of Francesco Forastiere, has increased very much the profile of ERS in Brussels, for instance, by participating in the debate on the threshold of fine particles and by organizing a workshop on the respiratory effects of climatic change;

the launch of the first European report on passive smoking ("Lifting the smokescreen....") which was presented at the European Parliament in Brussels.

2007-2008 - Leo Fabbri lists among the highlights of his term:

the first major research funding specific for respiratory diseases by the European Union (a result obtained thanks to a joint effort with previous presidents Viegi and McNee) including Innovative Medicines Initiative (IMI) on COPD and severe asthma, and the PAN-NET TB project awarded to ERS;

the largest ever World Respiratory Meeting held in Berlin in October 2008;

the First HERMES European Examination held in Berlin 2008;

the increased profile of ERS in the European scientific scenario linked to unprecedented intense inter-society collaborations particularly with cardiology (European Society of Cardiology, ESC) and infectious diseases (European Society of Clinical Microbiology and Infectious Diseases, ESMID).

Fabbri also paid tribute to the unique contribution of Archie Turnbull, who ended his invaluable service in 2007.